California Fines Anthem $9.6 Million

Paid 44% of the fines levied by Calif Dept of Managed Care
Robert Calandra

The California Department of Managed Health Care takes insurance company enrollee grievances seriously. Just ask Anthem Blue Cross.

The insurer has been hit with $9.6 million in fines from January 2014 through last month, according to Kaiser Health News and the Los Angeles Times.  That accounts for 44% of the $21.7 million the department issued against full-service health plans over that period.

Anthem covered 10% to 13% of Californians (roughly 3.8 million people) with state-approved plans during that five year period.  By comparison, Kaiser Permanente (not affiliated with Kaiser Health News) received 11% of the penalties but insured nearly a third of Californians in state-regulated plans.

Anthem was hit hard with penalties because it failed to properly handle enrolled grievances and appeals, department spokeswoman Rachel Arrezola told KHN via email.

The sanctions against the company make up more than a third of the 1,432 enforcement actions the department issued during that five year period.

Enforcement actions can include settlement agreements requiring plans to change bad practices, cease-and-desist orders, judicial rulings, and civil complaints.

The fines against Anthem are related to many of the 553 enforcement actions that the department has taken against the health plan for violations such as taking too long to respond to enrollee grievances, inappropriately denying claims and not covering the cost of out-of-network care that should have been covered.

“Anthem has been making significant changes in its grievance and appeals process, as well as investments in system improvements to help ensure we are simplifying the healthcare experience for consumers,” a company spokesman told KNH via email.